外伤性前颅底缺损的手术治疗

目的 探讨外伤性前颅底缺损的手术治疗方法。方法 对36例患者根据不同临床情况分别采用如下手术方法进行缺损修复:①游离骨膜片5例;②鼻内窥镜下修补3例;③带蒂额帽状鹏膜骨膜瓣16例;④带蒂颞肌筋膜骨膜瓣12例。所有患者均未移植骨修复颅底。结果 平均住院16 d,术前有脑脊液(CSF)漏、气颅、脑膜脑膨出及眼球突出或凹陷者术后均消失,无CSF漏、气颅及感染再发生。31例随访6个月至10年(平均4年),未发现有脑膜脑膨出发生。结论 颅底缺损直径<1cm且无合并颅内损伤、感染及异物存留的患者可经鼻内窥镜下手术修复缺损,但对急性复杂性颅脑-颅底颌面损伤或颅底缺损较大伴有异物、脓肿、脑膜脑膨出或气颅和CSF漏超过2周不愈者应尽早予清创和修复颅底缺损;带蒂额帽状腹膜骨膜瓣是修复颅底缺损最好的材料,但对于有额部皮肤软组织严重损伤患者则应选择带蒂颞肌筋膜骨膜瓣来修复颅底缺损。

The surgical treatment of the taumatic anterior skull-base detect

Objective To study the surgical treatment of the traumatic anterior skull-base defect. Methods Depending on individual patients oondition, 36 cases underwent surgical repair of the defect with dissociated pericranial flaps in 5, transnasal en-doscopic repair in 3, pedicled frontal galeal-pericranial flaps in 16, pedicled temporal musculo-pericranial flaps in 12. Bone graft was not applied in all cases. Results After operation, the preoperative manifestions were all resolved. Long-term follow-up in 31 patients ranged from 6 months to 10 years (average 4 years) showed neither recurrence of CSF leakage nor meningitis or en-cephalomeningocele were observed. Conclusions Transnasal endoscopic repair can be done in simple cases (the defect diameter < 1 cm) . Debridement and repaire should be considered as soon as possible in cases vvith not only acute serious traumatic anterior skull-base defect but also residual foreign bodies or inflammation and continuous CSF rhinorrhoea or air within the skull were found on CT or MRI for more than 2 weeks. The pedicled frontal galeo-pericranial flap is the best material for repairing the anterior skull-base defect. But in patients vvith serious frontal skin and soft tissue injury, the pedicled temporal musculo-pericranial flap is the best choice for repaired the cranial base defect.